子痫前期胎盘低氧诱导因子1α的表达及其与血清胎盘生长因子的相关性

目的检测正常晚期妊娠和子痫前期患者胎盘低氧诱导因子1α(H IF-1α)和血清胎盘生长因子(P lGF)的水平,探讨它们的相关性及与子痫前期发病的关系。方法免疫组织化学SP法检测40例子痫前期患者及20例正常晚期妊娠胎盘H IF-1α表达,酶联免疫吸附试验(ELISA)检测血清P lGF的水平。结果轻度子痫前期组与重度子痫前期组胎盘H IF-1α表达高于正常晚期妊娠组,两组血清P lGF低于正常晚期妊娠组,差异均有显著性意义(P<0.05)。胎盘H IF-1α的表达与血清P lGF水平呈负相关关系。结论子痫前期患者血清P lGF水平依赖于胎盘H IF-1α表达,两者可能与子痫前期的发病有一定关系。     

NO及VEGF、sFlt-1在早发型子痫前期胎盘中的表达及意义

目的检测VEGF、sFlt-1及NO在早发型子痫前期和晚发型子痫前期患者血清和胎盘中的表达。方法随机选取2013年5月至2014年6月规律产检并分娩的子痫前期孕妇75例,其中早发型子痫前期31例,晚发型子痫前期44例。选取同期健康晚期妊娠孕妇30例作为健康对照组,采用免疫组织化学SP法检测VEGF、sFlt-1的表达,用硝酸还原法测定胎盘中NO的表达,并进行相关性分析。结果早发型子痫前期患者胎盘组织中VEGF阳性表达率32.2%,晚发型组为61.4%,正常对照组为86.7%,3组差异有统计学意义(P0.05);早发型子痫前期患者胎盘组织中sFlt-1阳性表达率82.1%,晚发型组74.8%,正常对照组12.9%,3组差异有统计学意义(P0.05);NO的光密度结果在早发型子痫前期患者胎盘组织中是59.3±2.21,晚发型组为31.6±1.90,正常对照组89.9±2.17,3组差异有统计学意义(P0.05)。结论 sFlt-1在早发型子痫患者的胎盘组织中表达最高,抑制了其靶组织VEGF表达,影响了胎盘微血管形成;NO在早发型子痫患者的胎盘组织中表达最低,抑制了微血管的舒张。SFlt-1和NO与早发型子痫前期的发病密切相关。     

胎盘绒毛组织代谢足迹在早发型与晚发型重度子痫前期患者中的差异

目的对比研究早发型重度子痫前期患者和晚发型重度子痫前期患者胎盘绒毛组织在体外6%氧浓度下培养,其培养液中代谢足迹的差异。方法本研究纳入2014年1月至2016年12月就诊于我院重度子痫前期患者44例,根据子痫类型分为早发型重度子痫前期组(早发组21例)和晚发型重度子痫前期组(晚发组23例),全部患者接受剖宫产终止妊娠治疗。于胎盘母体面取绒毛组织,在6%氧浓度下培养96h,采用高效液相质谱色谱仪检测培养液中代谢产物。对比两组患者谷氨酸、谷氨酰胺、色氨酸和犬尿氨酸的浓度差异。结果在6%氧浓度下培养的早发组和晚发组绒毛组织中,36种代谢产物出现显著性差异(P0.05);早发型重度子痫前期患者的胎盘绒毛组织培养基中,犬尿氨酸的浓度显著高于晚发型重度子痫前期组(P0.05)。结论通过组织代谢足迹分析技术,犬尿氨酸含量可以有效鉴别早发型和晚发型重度子痫前期,对预测重度子痫前期提供新的技术途径,值得临床推广应用。     

sEPCR、VEGF、MVD、KDR在早发型子痫前期胎盘中的表达

目的 研究sEPCR、VEGF、MVD、KDR在早发型子痫前期胎盘中的表达情况.方法 选取2016年3月至2017年4月我院收治的早发型子痫前期患者50例为研究对象,以同期入院体检的50例健康产妇为对照组,测定入组对象胎盘组织中可溶性血管内皮细胞蛋白C受体(sEPCR)、血管内皮生长因子(VEGF)、胎盘微血管密度(MVD)、含有激酶插入区的受体(KDR)及可溶性血管内皮生长因子受体(sFlt-1)水平,同时比较子痫前期病情轻度、中重度患者上述指标,分析PE患者sEPCR、VEGF、MVD、KDR及sFlt-1的相关性,评价上述指标联合诊断PE的效能.结果 早发型组胎盘组织VEGF(30.25 ±1.87)％、MVD(37.11 ±1.54)条低于对照组(P＜0.05),而其sEPCR(156.34±1.25) ng/mL、KDR(70.34±1.38)％、sFlt-1 (80.32±1.67)％较对照组升高(P＜0.05);重度子痫前期患者VEGF(30.18±1.30)％、MVD(36.20±1.31)条与轻度组比较明显降低,而sEPCR(154.22±1.05)％、KDR(71.20±1.66)％、sFlt-1 (81.11±1.56)升高(P＜0.05);sEPCR、VEGF、MVD、KDR联合诊断早发型PE患者灵敏度为98.05％,特异性为93.11％,准确度为96.20％,均高于上述指标单项诊断;相关分析显示子痫前期患者胎盘组织中VEGF、MVD与sFlt-1呈负相关(P＜0.05).结论 sEPCR、VEGF、MVD、KDR在早发型子痫前期胎盘中呈异常表达,随病情加重VEGF、MVD表达降低,sEPCR、KDR表达增多,其中VEGF、MVD表达水平与sFlt-1高表达有关.     

MVD、VEGF、PLGF、sFlt-1在早发型子痫前期胎盘中的表达及意义

目的探讨VEGF、s Flt-1、PLGF、MVD在早发型子痫前期患者胎盘中的表达与胎盘血管病变的关系,并与晚发型子痫前期做比较。方法随机选取2013年5月至2014年6月规律产检并分娩的子痫前期孕妇105例,其中早发型子痫前期46例,晚发型子痫前期59例。选取同期健康孕妇50例作为健康对照组,采用免疫组织化学SP法检测MVD、VEGF、PLGF、s Flt-1的表达,CD34双标免疫组化法标记血管检测胎盘中的微血管密度值,并进行相关性分析。结果早发型子痫前期患者胎盘组织中VEGF阳性表达率30.4%,晚发型组为61.0%,正常对照组为90%,3组差异有统计学意义(P0.05);早发型子痫前期患者胎盘组织中s Flt-1阳性表达率80.4%,晚发型组76.3%,正常对照组14%,3组差异有统计学意义(P0.05);早发型子痫前期患者胎盘组织中PLGF阳性表达率21.7%,晚发型组为64.0%,正常对照组88%,3组差异有统计学意义(P0.05);早发型子痫前期患者胎盘组织中微血管密度(37.12±2.16),晚发型组(59.35±2.78),正常对照组(90.10±4.18),三组差异有统计学意义(P0.05)。结论 s Flt-1在早发型子痫患者的胎盘组织中高表达,抑制了其靶组织VEGF及PLGF表达,影响了胎盘微血管形成,引发了子痫前期的发生,s Flt-1出现越早,子痫前期发生越早。     

生长分化因子15在子痫前期胎盘滋养细胞中的表达及意义

目的探讨生长分化因子-15（GDF-15）在子痫前期患者胎盘滋养细胞中的表达,探讨其在子痫前期发病机制中的作用。方法选择2009年12月至2010年10月在青岛市市立医院住院分娩的子痫前期孕妇140例,其中早发型轻度子痫前期孕妇35例（早发轻度组）,晚发型轻度子痫前期孕妇35例（晚发轻度组）,早发型重度子痫前期孕妇35例（早发重度组）,晚发型重度子痫前期孕妇35例（晚发重度组）;另选同期健康孕妇35例为对照组。采用RT—PCR检测胎盘滋养细胞中GDF-15mRNA的表达量;采用免疫组化方法检测胎盘滋养细胞中GDF-15蛋白的表达。结果RT—PCR显示子痫前期各组胎盘滋养细胞中GDF-15mRNA表达水平均高于对照组,差异有统计学意义（P〈0．05）;但子痫前期各组间分别比较,差异无统计学意义（P〉0．05）。免疫组化显示GDF-15表达于胎盘滋养细胞的细胞浆和细胞外基质中,并在各组胎盘滋养细胞中均表达。子痫前期各组胎盘滋养细胞中GDF-15蛋白表达水平均高于对照组组,差异有统计学意义（P〈0．05）;但子痫前期各组间分别比较,差异无统计学意义（P〉0．05）。结论GDF-15在子痫前期胎盘滋养细胞中表达升高,GDF-15的表达水平变化可能与子痫前期发病有关。     

KiSS-1在子痫前期患者胎盘组织中的表达及意义

目的探讨肿瘤转移抑制基因KiSS-1是否是子痫前期的发病机制。方法采用免疫组化SP法检测25例正常足月妊娠妇女(正常妊娠组)与40例子痫前期患者(子痫前期组,其中轻度子痫前期15例、重度子痫前期25例)胎盘组织中KiSS-1的表达。结果KiSS-1主要位于胎盘绒毛小叶的合体滋养细胞。子痫前期组胎盘组织中KiSS-1的平均光密度为(0.137±0.010),其中轻度子痫前期为(0.132±0.004),重度子痫前期为(0.140±0.012);均明显高于正常妊娠组的(0.124±0.010),P值分别为P<0.01、P<0.05(P=0.019)、P<0.01。结论胎盘组织中KiSS-1的表达水平随病情程度的加重而增高,可能与子痫前期的发病有关。     

ERBB4/HER4在子痫前期胎盘中的表达

目的探讨子痫前期患者胎盘滋养细胞人表皮生长因子受体4(ERBB4/HER4)的表达及意义。方法采用RT-PCR法检测35例子痫前期患者(子痫前期组)胎盘ERBB4的表达及其与胎盘重量及新生儿出生体重的关系,并与20例正常妊娠妇女(正常妊娠组)比较。结果在子痫前期患者胎盘中,ERBB4 mRNA表达明显高于正常妊娠胎盘,两者有显著性差异(P<0.05)。结论子痫前期患者胎盘ERBB4表达显著增高,与子痫前期的发病密切相关。     

TNF-α及TGF-β1 mRNA在子痫前期患者胎盘组织中的表达及意义

目的探讨肿瘤坏死因子-αmRNA（TNF-α mRNA）及转化生长因子-β1mRNA（TGF-β1mRNA）在在子痫前期患者胎盘组织中的表达及临床意义。方法采用RT-PCR技术检测45例正常晚期妊娠妇女及56例子痫前期患者（其中轻度子痫前期21例,重度子痫前期35例）胎盘组织中TNF-α mRNA及TGF-β mRNA的表达水平。结果1.轻、重度子痫前期胎盘组织中TNF-α mRNA表达水平分别为：0.371±0.12、0.892±0.347均明显高于正常妊娠组0.138±0.092（均P〈0.01）,重度子痫前期组高于轻度子痫前期组（P〈0.01）。2.轻、重度子痫前期胎盘组织中TGF-β1mR-NA表达水平分别为：0.752±0.133、1.016±0.346均明显高于正常妊娠组0.384±0.098（均P〈0.01）,重度子痫前期组高于轻度子痫前期组（P〈0.01）。结沦子痫前期胎盘组织中TNF-α mRNA及TGF-β1mRNA表达水平明显升高,并且与子痫前期病情发展密切相关,可作为评价病情严重程度的指标。     

基质金属蛋白酶-9和血管内皮生长因子在子痫前期患者胎盘组织中的表达

目的 检测子痫前期患者胎盘组织中RECK、基质金属蛋白酶-9（MMP-9）、血管内皮生长因子（VEGF）的基因表达,探讨它们与胎盘滋养细胞浸润过程的调控关系。 方法 采用RT-PCR、Western blotting、免疫组织化学检测120例妊娠足月剖宫产（正常妊娠、轻度子痫前期、中度子痫前期、重度子痫前期各30例）胎盘组织中RECK、MMP-9、VEGF的基因表达。结果 3组子痫前期患者胎盘组织中MMP-9及VEGF的mRNA表达水平均显著低于正常妊娠组（P<0.05）;重度子痫前期组中RECK mRNA的表达显著高于正常妊娠组（P<0.05）;3组子痫前期患者胎盘组织中MMP-9及VEGF蛋白表达均显著低于正常妊娠组（P<0.05）,中度和重度子痫前期组中RECK蛋白表达显著高于正常妊娠组（P<0.05）。结论 子痫前期患者胎盘中RECK与MMP-9、VEGF之间存在负相关性,它们可能参与了胎盘滋养细胞浅浸润过程的调控。     

Placental expression of vascular endothelial growth factor receptor-1/soluble vascular endothelial growth factor receptor-1 correlates with severity of clinical preeclampsia and villous hypermaturity

Overexpression of soluble vascular endothelial growth factor receptor-1 has been linked to preeclampsia and is thought to be secondary to placental insufficiency caused by hypoxia. Villous hypermaturity, characterized by presence of increased syncytial knots, has been associated with syndromes of placental insufficiency, particularly when severe. This study was undertaken to determine whether there is a link between soluble vascular endothelial growth factor receptor-1 expression, villous hypermaturity, and clinical severity of preeclampsia. We conducted a retrospective cohort study in which 48 placentas were selected from pathology archives (hypertensive group). Of these, 6 had chronic hypertension, 15 had mild preeclampsia, 14 had severe preeclampsia, and 13 had hemolysis, elevated liver enzymes, and low platelets syndrome. These were compared with 55 placentas from normotensive patients (control group). One representative section of placental parenchyma from each case was stained with an antibody to vascular endothelial growth factor receptor-1/soluble vascular endothelial growth factor receptor-1 and given a score based on extent and intensity of staining, representing expression level. Assignment of staining score was done, blinded to clinical history and pathologic diagnosis. Vascular endothelial growth factor receptor-1/soluble vascular endothelial growth factor receptor-1 staining was seen in placental syncytiotrophoblasts and was particularly strong in syncytial knots. There was a positive association between vascular endothelial growth factor receptor-1/soluble vascular endothelial growth factor receptor-1 staining score and severity of clinical hypertensive state, small placental size, and villous hypermaturity. The association between vascular endothelial growth factor receptor-1/soluble vascular endothelial growth factor receptor-1 score and small placentas did not persist after controlling for hypermaturity. Vascular endothelial growth factor receptor-1/soluble vascular endothelial growth factor receptor-1 overexpression in the placenta strongly correlates with both severity of hypertensive disease and villous hypermaturity. The correlation with villous hypermaturity further links hypoxia to vascular endothelial growth factor receptor-1/soluble vascular endothelial growth factor receptor-1 production in the placenta.     

妊娠期高血压疾病胎盘组织中CASR和EGFR的相关研究

目的探讨在妊娠期高血压疾病患者胎盘组织中细胞外钙受体（CASR）和表皮生长因子受体（EGFR）的表达情况及其相互关系。方法通过免疫组织化学方法检测妊娠期高血压疾病患者64例（妊娠期高血压组21例,子痫前期轻度组23例,重度组20例）及健康足月孕妇20例（对照组）胎盘组织中CASR和EGFR蛋白的表达情况。结果 （1）妊娠期高血压疾病患者胎盘组织中CASR在妊娠期高血压组表达水平为59.0532±8.039,子痫前期轻度组患者中为64.3623±3.7278,两组比较,差异有统计学意义（P〈0.0001）;CASR在子痫前期重度组患者中表达为112.2831±6.2060,与妊娠期高血压组比较,差异有统计学意义（P〈0.0001）,与子痫前期轻度组比较,差异有统计学意义（P〈0.0001）。CASR的蛋白在妊娠期高血压组患者胎盘组织中表达水平为59.0532±8.039,对照组为54.8585±4.3035,两组比较,差异无显著性（t=0.08,P=0.7759）。（2）妊娠期高血压疾病患者胎盘组织中表皮生长因子受体（EGFR）在妊娠期高血压组表达水平为56.174±3.1020,子痫前期轻度组患者中为78.6844±2.6713,两组比较,差异有统计学意义（t=18.73,P=0.0001）;EGFR在子痫前期重度组患者中表达为94.2090±6.8352,与子痫前期轻度组比较,差异有统计学意义（t=11.37,P〈0.0001）。（3）胎盘组织中CASR和表皮生长因子受体（EGFR）表达量呈正相关关系（r=0.352,P〈0.05）。结论妊娠期高血压疾病患者胎盘组织中CASR的蛋白表达升高和EGFR激活及过度增高,可能在妊娠期高血压疾病发生发展中起重要作用。     

Impaired placental neovascularization in mice with pregnancy-associated hypertension

Preeclampsia is a serious disorder that may result in severe morbidity and mortality for mother and fetus, and it is thought that the placental dysfunction is important in the pathogenesis of preeclampsia. As the model of preeclampsia, we previously generated a transgenic mouse model that developed pregnancy-associated hypertension (PAH) by mating females expressing human angiotensinogen with males expressing human renin. In PAH mice, maternal blood pressure started to rise from days 12 to 13 of gestation (E12-13) to term (E19-20), which is accompanied by the fetal intrauterine growth retardation and systemic maternal disorders including proteinuria and convulsion. To understand the pathology of the complications in PAH mice that overlap with those in human preeclampsia, we analyzed the PAH placenta sequentially from the onset of hypertension to the term of delivery. In PAH placenta, histological analysis revealed that the microvessel densities of fetal vasculature at term were significantly lower than those of normal placenta, and the majority of terminal vessels of PAH placenta were lacking for pericytes and basement membrane. The interaction between fetal vasculature and maternal blood canal at labyrinth of PAH placenta was morphologically distorted, and the expression patterns of key molecules in neovascularization of PAH placenta were distinct from those of normal placenta during pregnancy. In addition, maternal plasma level of soluble form of vascular endothelial growth factor receptor-1 (sVEGFR-1) was significantly increased in PAH at E19. Furthermore, in uteroplacental site, in situ proteolytic activity of PAH mice was suppressed from E16 to term compared to that of normal pregnancy, and the expression of matrix metalloproteinase-2 mRNA was strikingly downregulated at E16 in PAH mice. Collective data suggest that the impairments of fetoplacental neovascularization and uteroplacental remodeling contribute to the development of complications in PAH.     

Determinants of placental vascularity

PROBLEM: Vascular growth during implantation and placentation is critical for successful gestation and it is thought that vascular insufficiencies during placentation contribute to a number of obstetrical complications. However, relatively little is known regarding the regulation of angiogenesis in the placenta. METHOD OF STUDY: We review literature concerning the potential significance of inadequate placental vascularity as a contributor to the obstetrical complications of spontaneous abortion, fetal growth restriction and preeclampsia. Gene expression assays were used to compare fluctuations of placenta growth factor (PlGF) and PlGF receptor expression in normal and preeclamptic trophoblast in vitro. RESULTS: Studies have shown that common obstetrical complications manifest altered placental vascularity. Both intrinsic defects (gene knockouts) and extrinsic factors (O(2) tension, cytokines, etc) may be responsible for the defects. Some of these factors have been shown to influence trophoblast vascular endothelial growth factor (VEGF)/PlGF expression suggesting this particular family of angiogenic proteins play an important role in placental angiogenesis. CONCLUSION: Placental vascularization reflects a complex interaction of regulatory factors. Understanding the regulation of vascular growth in the placenta will provide much needed insight into placenta-related vascular insufficiencies.     

Increased levels of macrophage colony-stimulating factor in the placenta and blood in preeclampsia

PROBLEM: Macrophage colony-stimulating factor (M-CSF) is considered an essential cytokine for placental growth and maintenance. We evaluated whether M-CSF levels in the placenta and blood in preeclampsia differed from those in normal pregnancies. METHOD OF STUDY: The subjects were 37 pregnant women carrying single fetuses, of whom 19 were women with normal pregnancies and 18 were women with preeclampsia. Their average gestational age at entry was 38 weeks of gestation. Blood was collected before the onset of labor, and separated serum was obtained after centrifugation. A tissue segment of the placenta was cut immediately after delivery. The frozen placental tissue was placed in a plastic tube containing phosphate-buffered saline. The tissue was fully homogenized and then centrifuged. Separated supernatant was used for subsequent determination. M-CSF levels in separated serum were measured, and M-CSF and total protein (TP) levels in separated supernatant were also measured. RESULTS: Both M-CSF/TP levels in the placenta and M-CSF levels in blood were significantly higher (P < 0.05-0.01) in preeclampsia than in normal pregnancies. CONCLUSIONS: This is the first report concerning high placenta levels of M-CSF/ TP in preeclampsia. Increased M-CSF in the placenta supports the hypothesis that immunological abnormalities contribute to the etiology of preeclampsia.     

子痫前期胎盘浅植入理论研究进展

子痫前期迄今为止病因不明。目前研究发现胰岛素样生长因子-1（IGF-1）、胰岛素样生长因子结合蛋白-1（IGFBP-1）与血管内皮生长因子（VEGF）在妊娠早期的异常表达引起子宫血管床发育障碍而形成的胎盘浅植入是子痫前期发病的重要原因。同时Fas/Fasl基因与NK细胞的高表达引起母婴之间免疫失衡,造成胎盘滋养细胞侵润功能不足、导致胎盘异常植入可能为子痫前期的另一病因。     

转化生长因子-β1在子痫前期患者胎盘组织中的表达研究

目的探讨转化生长因子-β1mRNA（TGF—β1mRNA）在子痫前期发病机制中的作用。方法采用RT—PCR技术检测45例正常晚期妊娠妇女及56例子痫前期患者（其中轻度子痫前期21例，重度子痫前期35例）胎盘组织中TGF－β3mRNA的表达水平。结果轻、重度子痫前期胎盘组织中TGF－β1mRNA表达水平分别为：0．752±0．133、1．0164-0．346均明显高于正常妊娠组0．384±0．098（均P〈0．01），重度子痫前期组高于轻度子痫前期组（P〈0．01）。子痫前期胎盘组织中TGF-β1mRNA表达水平与24h尿蛋白、血压、新生儿体重及胎盘重量均有明显相关性。结论1．子痫前期胎盘组织中TGF-β1mRNA表达水平明显升高，并且与子痫前期病情发展密切相关。2．胎盘组织TGF－β1mRNA的表达水平与子痫前期患者胎儿发育密切相关。     

滋养细胞自噬在重度子痫前期发病中的作用与分子机制

目的:研究重度子痫前期患者胎盘滋养细胞自噬的发生规律及其导致细胞受损的可能机制。方法:收集23例重度子痫前期患者及23例正常孕妇的胎盘组织,应用扫描电镜观察胎盘绒毛表面的变化;透射电镜观察滋养细胞超微结构及自噬体形成;免疫组化检测胎盘组织自噬相关蛋白Beclin-1、LC3Ⅱ的表达变化,并将其相对表达量与胎盘重量、新生儿体质量进行相关性分析。结果:与对照组相比,重度子痫前期患者胎盘组织在扫描电镜下见绒毛稀少、排列紊乱等结构异常;透射电镜下见细胞质中典型的自噬体形成;免疫组化提示Beclin-1、LC3Ⅱ等蛋白表达显著升高(P<0.01),其相对表达量与胎盘重量、新生儿体质量呈负相关,Beclin-1,LC3Ⅱ与胎盘重量、新生儿体质量的相关系数分别为-0.977、-0.930,-0.812、-0.849。结论:重度子痫前期患者滋养细胞Beclin-1、LC3Ⅱ等蛋白的表达增加,自噬活性增高,与胎盘重量、新生儿体质量呈负相关。     

子痫前期患者白细胞介素-8和胎盘生长因子的表达及其意义

目的通过检测子痫前期患者羊水中白细胞介素-8（IL-8）和胎盘组织中胎盘生长因子（PLGF）的水平．以探讨IL-8和PLGF在子痫前期发病中的作用。方法采用酶联免疫吸附法和免疫组化法分别测定20例轻度子痫前期患者,22例重度子痫前期患者和30例正常妊娠妇女（对照组）的羊水中IL-8和胎盘组织中的PLGF的表达。结果子痫前期轻度组及重度组羊水IL-8均高于对照组,重度组羊水IL-8显著高于轻度组,差异均有统计学意义（P〈0．01）。子痫前期轻度组及重度组胎盘组织中PLGF表达量均低于对照组（P〈0．01）,而重度组低于轻度组（P〈0．01）。子痫前期轻、重度组及对照组胎盘组织中PLGF表达量与羊水IL-8水平均呈高度负相关（P〈0．01）。结论子痫前期患者羊水中IL-8增高,而胎盘组织中PLGF表达下降,可能与子痫前期的发生、发展有关。